Provider Demographics
NPI:1639644024
Name:CYNTHIA WORNSTAFF NP LLC
Entity Type:Organization
Organization Name:CYNTHIA WORNSTAFF NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WORNSTAFF
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:907-965-4040
Mailing Address - Street 1:3528 TONGASS AVE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5635
Mailing Address - Country:US
Mailing Address - Phone:907-965-4040
Mailing Address - Fax:844-742-6548
Practice Address - Street 1:3528 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5635
Practice Address - Country:US
Practice Address - Phone:907-965-4040
Practice Address - Fax:844-742-6548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP0234Medicaid